New drugs add tools, but fight against obesity continues

Updated 10:55 pm, Saturday, August 4, 2012

George Salazar, who works in Methodist Hospital's business office in the Texas Medical Center, has lost more than 100 pounds through a nonsurgical weight management program at the hospital.

George Salazar, who works in Methodist Hospital's business office in the Texas Medical Center, has lost more than 100 pounds through a nonsurgical weight management program at the hospital.

Photo: Johnny Hanson

Image 2 of 3

Salazar once topped the scales at 299 pounds at 5 feet 7 inches tall.

Salazar once topped the scales at 299 pounds at 5 feet 7 inches tall.

Image 3 of 3

George Salazar, who works in Methodist Hospital's business office in the Texas Medical Center, has lost more than 100 pounds through a nonsurgical weight management program at the hospital.

George Salazar, who works in Methodist Hospital's business office in the Texas Medical Center, has lost more than 100 pounds through a nonsurgical weight management program at the hospital.

New drugs add tools, but fight against obesity continues

1 / 3

Back to Gallery

Luis Rustveld can offer help but no shortcuts for losing weight.

"There is no magic bullet," he says.

But the past decade has given people on the front lines - Rustveld is a dietitian and assistant professor at Baylor College of Medicine - as well as those afraid to step on the bathroom scale unprecedented insight into why losing weight, and keeping it off, has become one of the country's most complicated public health problems.

This summer alone, the Food and Drug Administration has approved two new weight-loss drugs, the first in more than a dozen years. The U.S. Preventive Services Task Force recommended doctors screen all patients for obesity and refer for treatment those who qualify, an acknowledgment of the health risks carried by the additional pounds.

Scientists understand the disease is not as simple as they once believed.

But the additional knowledge hasn't slowed the rate at which Americans are packing on the pounds. Two-thirds of people in the United States are overweight or obese, with all of the health problems that brings: Type 2 diabetes, high blood pressure, high cholesterol, coronary artery disease, sleep apnea and more.

Breaking a streak

Calories still matter, and so far no drug can change that.

But the right drugs can jump-start a weight-loss program, and the FDA's approval this summer of two weight-loss pills breaks a cautious streak brought about in the late 1990s by evidence that the wildly popular "fen-phen" combination caused heart valve damage and primary pulmonary hypertension. Fenfluramine and phentermine were pulled from the market, although phentermine is one of two drugs used to create the just-approved Qsymia.

The FDA has ordered a longer-term study of Qsymia to assess cardiovascular risks, said Dr. Christie Ballantyne, chief of cardiology at Baylor.

But obesity is also bad for the heart.

"It may be prudent to wait, but it is good news we have two new therapies which show efficacy for weight loss and in the data we have, appear to have manageable side effects," Ballantyne said. "All drugs have side effects."

Keeping weight off is at least as hard as losing it, and both Qsymia and the second new drug, Belviq, may help maintain weight loss, said Dr. Peter Howard Jones, medical director of the weight management program at Methodist Wellness Services.

But pills alone won't work unless people also cut calories and add exercise.

For dietitians to support the use of diet pills, even cautiously, is relatively new, brought about by research proving that some people suffer from intense cravings and the inability to know when they are full.

"There are people that, their entire day is preoccupied with food," Rustveld said. "If they know the food is in the kitchen, it makes it very difficult for them to concentrate."

Brain imaging techniques have shown it's not about willpower, he said. "For a sector of the population, that's not enough."

Focusing on the basics

But for most, consuming fewer calories and adding more exercise works. At least for a while.

"I have tried many weight programs," said Dee Selinidis, who is 69. "I would lose 10 pounds, and in six months, eight months, I would gain back 15 pounds."

Last fall she accompanied her husband, Konstantinos, to a class run by Rustveld. They both needed to lose weight, and Konstantinos Selinidis needed better control over his Type 2 diabetes.

Rustveld focused on the basics - fresh foods, more vegetables, less butter and cream - and they each lost 30 pounds.

Konstantinos Selinidis, 75, reduced the amount of medications he needed, and the bill for his diabetes drugs dropped by two-thirds, to $1,000 a year.

"I have good insurance," he said. "But think of the money the insurance company has saved."

The Selinidises didn't use any trendy diets - no Atkins, no grapefruit or cabbage soup diet - allowing them to avoid what Gee calls "diet fatigue."

"People get tired of calorie counting," she said. "They get bored."

Sleep a factor

Even sleep problems can affect weight.

"If someone is not getting enough sleep, that throws off their appetite-regulating hormones," said Kari Kooi, a Methodist Wellness Services dietician.

People who sleep less than six hours a night produce too much ghrelin, which indicates hunger, and too little leptin, which indicates satiety, or fullness, she said.

The National Weight Control Registry tracks people who have lost at least 30 pounds and kept it off for a year or longer. The average registry member has lost 66 pounds and kept it off for 5½ years.

George Salazar hasn't made it five years, but he's determined to get there. In April 2011, Salazar, at 5 feet 7 inches, weighed 299 pounds.

He played sports in high school and blew out his knee. When the recovery from his second knee reconstruction surgery in 2009 was painfully slow, his doctor offered the obvious explanation: He weighed too much.

Salazar, 42, works in Methodist's business office and went through the hospital's weight management program. For seven months, he had protein shakes at every meal, occasionally substituting soup for dinner, and he walked every evening with his wife, Gracie.

Then he'd putter around the yard.

"I'd do anything to keep my mind off being hungry," he said.

He's down to 195 pounds and training for a half-marathon.

Better understanding

Scientists are trying to better understand how the body regulates energy and what makes some people resistant to traditional weight-loss techniques.

Qingchun Tong, an assistant professor in the Center for Metabolic and Degenerative Disease at the UT Health Science Center, looks at how the brain regulates whole-body energy balance and fuel metabolism, work that could result in a new class of weight-loss drugs.

"Each individual has their own set-point," he said. "A lot of that is controlled by the brain. I think the answer is in the brain."

Other researchers are looking elsewhere.

Chappell, who works at UTHealth in the School of Public Health, and colleague Susie Day, an epidemiologist, are examining the relationship between obesity and a strain of adenovirus, a wide-ranging category of virus with 58 known strains.

Researchers don't know how adenovirus 36 is transmitted, Chappell said, but about 30 percent of obese people are infected with the strain, compared with 11 percent of people who are not obese.

Day said that proving a link, or even developing a vaccine, won't give people an excuse for overeating.

"Obesity is a multi­factoral, chronic disease, much like cardiovascular disease and cancer," she said. "It's not one thing that causes any chronic illness."

And science can't find effective treatments until it knows all the factors that cause obesity, Chappell said. "Certainly, we're not being successful now."